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Role of Modern Imaging with FDG-PET/CT in Aggressive Lymphoma

  • Judith TrotmanEmail author
  • Michel Meignan
Chapter
Part of the Hematologic Malignancies book series (HEMATOLOGIC)

Abstract

Use of imaging for staging and response assessment of aggressive lymphomas has appropriately moved from anatomic imaging with CT scanning alone to capturing both anatomic and metabolic information with combined PET-CT. The poorer prognosis of patients who fail to obtain a complete metabolic response after rituximab-chemotherapy has driven interim PET-CT assessment applying the 5-point scale or measuring changes in the standardised uptake value (ΔSUV). However with variations in chemotherapy regimen, timing and methodology across studies, the positive predictive value of interim PET remains too low to recommend its uniform application in routine clinical practice.

More recently, PET studies across a range of lymphomas including DLBCL and peripheral T-cell lymphoma suggest that calculation of the baseline total metabolic tumour volume (TMTV) may more accurately quantify tumour burden for determining prognosis. With standardisation of PET acquisition and the use of more sophisticated software, total metabolic tumour volume (TMTV) calculations are becoming feasible. TMTV has the potential to provide the single most efficient and relevant means of informing clinicians and patients of their disease burden. Given the poorer prognosis of patients with higher TMTV, this has potential to be integrated with end-of-induction PET and the molecular profile of lymphoma to better identify patients for whom a standard approach will provide a high probability of cure and those for whom more aggressive approaches could be applied. Translating the knowledge acquired from sophisticated technology into a simple reproducible message to convey prognosis and tailor therapy for patients across an increasingly complex spectrum of aggressive lymphomas is the current challenge for the PET physician and haematologist research collaborations.

Keywords

Total metabolic tumour volume Interim PET End-of-induction PET 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Haematology, Concord Repatriation General HospitalUniversity of SydneyConcordAustralia
  2. 2.LYSA Imaging, Hôpitaux Universitaires Henri MondorCréteilFrance

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